1/18. Scar endometriosis manifested as a recurrent inguinal hernia.A 24-year-old woman was initially found to have a right inguinal hernia that occurred suddenly after heavy lifting. A right direct inguinal hernia was found during the initial operative procedure. The round ligament was excised, the internal ring was closed, and the hernia was repaired with mesh placed on the floor of the inguinal canal. Four months after an uneventful postoperative recovery, the patient returned with pain in the right inguinal area. Over the next 2 months, a deep painful bulge developed. Inguinal exploration revealed an endometrioma rather than recurrent inguinal hernia. A portion of the original hernia incision included part of a previous Pfannenstiel incision made 3 years previously for a cesarean section. Scar endometriosis most probably occurred from peritoneal seeding from the Pfannenstiel incision and mimicked the findings of a recurrent inguinal hernia.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/18. Inguinal endometriosis or irreducible hernia? A difficult preoperative diagnosis.Two cases of endometriosis infiltrating the round ligament and associated with an inguinal hernia are presented. The initial diagnosis was irreducible hernia, since this rare association often causes unusual preoperative symptoms and diagnostic problems. diagnosis is frequently made by histologic examination. Surgery is the treatment of choice both for hernia and for endometriosis, and is locally curative. However, in a fertile woman with a painful mass in the inguinal region the possibility of endometriosis should be considered, and if suspected at inguinal exploration a laparoscopy should be made to rule out the presence of intraperitoneal endometriosis.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/18. round ligament varicosities mimicking inguinal hernia: a diagnostic challenge during pregnancy.groin swelling first evokes inguinal or femoral hernia but many other conditions may account for it. We describe varicosities of round ligament in a 27-year-old pregnant woman. She presented with a groin mass mimicking an inguinal hernia. diagnosis was made during surgical exploration. This case report strengthens the fact that varicosities of the round ligament, favoured by hormonal and mechanical factors, should be evoked in a pregnant woman complaining of a groin mass. Ultrasonographic examination of the groin should be performed in such cases to avoid unnecessary surgery.- - - - - - - - - - ranking = 6keywords = ligament (Clic here for more details about this article) |
4/18. Bilateral cryptorchidism with bilateral inguinal hernia and retrovesical mass in an infertile man: single-stage laparoscopic management.A 30-year-old married man presented with the complaint of inability to procreate. Examination revealed bilateral nonpalpable testes and bilateral inguinal hernia. ultrasonography of the abdomen could not locate the testis; instead, a hypoechoic 5 x 5-cm mass was found behind the bladder. A CT scan of the abdomen revealed the right testis near the right inguinal canal. The left testis could not be identified beside the soft tissue mass. The patient was taken for diagnostic as well as therapeutic laparoscopy. The testis on the right was found just proximal to the internal inguinal ring, and right orchidopexy was done. The left testis was small and rudimentary; hence, orchidectomy was done. Bilateral laparoscopic herniorrhaphy was carried out with polypropylene mesh by fixing it intracorporeally to the pubic bone, Cooper's ligament, inguinal ligament, and conjoint tendon. Subsequently, the retrovesical mass was excised and retrieved by dilating the umbilical port site. The operative time was 3.5 hours with minimal blood loss. The postoperative period was uneventful, and the patient was discharged after 24 hours. The histopathology examination of the retrovesical mass showed an extragonadal germ cell tumor compatible with seminoma.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
5/18. Previous appendicitis may affect peritoneal overlap of the mesh in laparoscopic inguinal hernia repair.Laparoscopic inguinal hernia repair is now increasingly performed in bilateral and recurrent groin hernias. The avoidance of direct exposure of the commonly used meshes to the abdominal viscera is considered essential to reduce the risk of bowel adhesions. We report a case of bilateral inguinal hernia repair in a patients who had had an appendectomy performed 8 years earlier for a perforated appendicitis. Probably as a result of previous inflammation, any attempt to dissect the preperitoneal layer in the right side resulted in peritoneal lacerations. Since the peritoneum could not be used to cover the mesh, we decided to position an expanded polytetrafluoroethylene (e-PTFE) mesh to avoid postoperative adhesions. The mesh was fixed with tacks to the symphysis pubis, Cooper's ligament, the ilio-pubic tract, and the transversalis fascia 2 cm above the hernia defect. This case suggests that in patient with previous appendicitis, a difficult preperitoneal dissection can be expected. In such cases, especially in young patients for whom future surgical operations cannot be excluded, any attempt to reduce adhesions is justified. At the present time, the use of e-PTFE meshes, which induce no tissue reaction, is a good option in this situation.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
6/18. Preperitoneal collection after endoscopic extraperitoneal inguinal hernioplasty in a patient with malignant ascites.Painful preperitoneal collection is a rare complication following endoscopic totally extraperitoneal inguinal hemioplasty. Here we present the case of a woman who underwent endoscopic extraperitoneal inguinal hernioplasty for a left inguinal hernia. Her past health was good. During the dissection of the extraperitoneal space, clear ascitic fluid was noted upon breaching the peritoneum near the round ligament. Endoscopic stapling was used to close the peritoneal tear, and the procedure was completed uneventfully. The patient complained of left iliac pain after the operation. A physical examination showed no swelling over the left iliac fossa. Contrast computed tomography of the abdomen revealed preperitoneal fluid collection over the hernioplasty site and a small amount of ascites. Expectant treatment with pain control by oral analgesics was adopted. A follow-up CT scan 4 months after the operation showed resolution of the preperitoneal fluid collection but with increased ascites. Abdominal paracentesis with peritoneal fluid for cytology analysis found adenocarcinoma cells. The patient succumbed to a terminal malignancy a year after surgery. Conversion of endoscopic extraperitoneal inguinal hernioplasty to open repair should be considered upon intraoperative discovery of ascites. Painful preperitoneal collection is a possible sequela following endoscopic extraperitoneal hernioplasty in patients with malignant ascites.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
7/18. Umbilical and bilateral inguinal hernias in a veteran powerlifter: is it a pressure-overload syndrome?Umbilical, inguinal and hiatal hernias are all thought to occur from basically the same etiology, a malformation in the tissue leading to herniation. The mechanisms for these malformations range from congenital to degenerative. Earlier studies proposed that hiatal hernias result from age-related degenerative changes in the phrenoesophageal ligament leading to subsequent herniation. We found that hiatal hernias occur in young power athletes secondary to intra-abdominal pressure overload of the phrenoesophageal ligament. We present a case of umbilical and bilateral inguinal hernias occurring in a veteran powerlifter. The pathogenesis of multiple hernias and the physiological pressure systems involved in the development of multiple hernias in a power athlete are discussed.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
8/18. Inguinal endometriosis.INTRODUCTION: Extrapelvic endometriosis is a rarely seen condition and it is occasionally presented to the general surgeons. It is often diagnosed incidentally. CASE REPORT: In this report we presented three cases of inguinal endometriosis all of which were thought to be inguinal hernia preoperatively. They were diagnosed during the operation for inguinal hernia repair and treated with simple excision of the lesions with a part of the round ligament.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
9/18. A mesothelial cyst of the round ligament presenting as an inguinal hernia after gonadotropin stimulation for in vitro fertilization.OBJECTIVE: To report the case of a round ligament cyst which, as the result of gonadotropin stimulation for IVF, simulated an incarcerated inguinal hernia. DESIGN: Case report. SETTING: A private infertility center and a university hospital. PATIENT(S): A 31-year-old woman who developed left lower quadrant pain after gonadotropin stimulation for IUI and a tender left inguinal mass after increasing ovarian stimulation for IVF/intracytoplasmic sperm injection. INTERVENTION(S): Surgical excision of a mesothelial cyst of the left round ligament and exploration of the left inguinal canal. MAIN OUTCOME MEASURE(S): Successful surgical excision of left inguinal mass. RESULT(S): Resolution of symptoms. CONCLUSION(S): Mesothelial cysts of the round ligament should be included in the differential diagnosis of inguinal masses in women. Gonadotropin stimulation might cause previously unrecognized cysts to simulate an incarcerated inguinal hernia, necessitating surgical repair.- - - - - - - - - - ranking = 7keywords = ligament (Clic here for more details about this article) |
10/18. parovarian cyst presenting as a groin hernia. A case report.An inguinal hernia containing a parovarian cyst is extremely rare. This phenomenon occurred in a 77-year-old woman who presented with a right groin hernia. The hernia contained a cystic mass that arose between the leaves of the broad ligament and passed with the round ligament through the deep inguinal ring. Through a midline incision the hernial content was mobilized, reduced through the inguinal ring and removed from the abdomen with both ovaries, tubes and uterus. The mass was found to be a parovarian cyst of the mesothelial type.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
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